Santa Clara Health Care Fraud Lawyers File False Claims Act Claims
Some of the biggest recoveries under the federal False Claims Act are for healthcare fraud. The wrongdoers include big pharma, doctors, hospitals, and other healthcare providers. The Department of Justice prosecutes health care fraud when whistleblowers disclose fraud to the department or when then department brings its own claim. Whistleblowers who successfully disclose fraud, with the help of legal counsel, are entitled to a substantial percentage of any recovery. Recoveries include the ill-gotten gains plus statutory fines.
Our Santa Clara California whistleblower lawyers have been advising whistleblowers for nearly 40 years. We explain if you have a claim and then prepare valid claims with the aim of having the Department of Justice accept the claim.
Healthcare fraud in Santa Clara
Anyone with knowledge of healthcare fraud by an employer or any entity that they work with can make a whistleblower disclosure. This includes nurses, doctors, contractors, pharmaceutical reps, and other healthcare workers. The Federal False Claims act protects federal agencies from fraud. In the healthcare care sector, they protect:
- Medicare for senior care
- Medicare Part D – for drug expenses
- Medicaid for low-income patients
- Tricare for retired members of the military and their spouses and underage children
- Medicare for SSDI recipients
Types of healthcare fraud
Doctors, medical practices, hospitals, laboratories, and other medical professionals and companies commit fraud when submitting the following types of claims:
- Billing the government for services they never performed
- Billing the government for treating patients who are just computer entries – not real patients
- Upcoding – submitting insurance codes for more expensive services than are justified
- Charging for services and treatments that are not necessary
- Falsifying certifications of their personnel
- Inflating the patient bill or the cost of overhead
- Redlining – discriminating in favor of healthy patients to get a fee so they don’t have to do much work to earn the fee
One of the major areas of healthcare fraud is committed by pharmacy manufacturers and their agents. The manufacturers commit can commit fraud in several ways including:
- Off-label marketing. Doctors can recommend drugs to their patients that aren’t indicated on the FDA labels for the drugs. Pharmacy companies cannot make such recommendations to the doctors and wholesalers they work with. Some pharmacy makers try to get around this requirement by inducing doctors to make off-label recommendations to their patients.
- Illegal incentives. Some pharmacy makers, whether the drugs are off-label or indicated by the label, offer illegal incentives to the doctors and hospitals to favor their drugs over the medications of other companies or treatments that don’t’ require medications. These illegal incentives include cash, putting a doctor on the payroll of board even though the doctor doesn’t work for the board, fancy meals or vacations, and other benefits.
- Best Medicaid price violations. Pharmacies must offer Medicaid the best price for the drugs. Some pharmacy manufacturers say they are doing this and then offer private companies a lower price.
Inflating the price of the drug and knowingly failing to follow FDA requirements may also qualify for a False Claims Act case.
Stark and Anti-Kickback anti-referral laws
Congress enacted several federal laws to ensure that doctors make referrals and recommendations to patients solely on the needs of the patient – and not on any financial incentive the doctor or hospital may have.
Stark Law and the AKS are similar. They both apply to Medicare and Medicaid. The AKS also applies to other agencies. Both have strict requirements for when referrals are illegal and when exceptions apply.
As a general rule, violations of either Stark Law or the AKS are also violations of the False Claims Act.
Research and development fraud
Private companies and educational institutions rely on federal grants and tax credits to help fund their research and development. The government has the right to trust that:
- The information on the application is accurate
- The data and results aren’t altered
- The grant money is used only for the research and development
- The research team/company complies with FDA and other applicable laws
At Stephen Danz & Associates, our Santa Clara False Claims Act lawyers work with healthcare and financial professionals to show when fraud is taking place. We prepare the necessary documentation to help persuade the government to accept your False Claims Act case. To learn more about your whistleblower rights, call us at (877)789-9707 or complete our contact form to make an appointment. Se habla espanol.